MEDICARE: RACHEL ROSS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	012270	OH

General Provider Information

NPI Number	:	1760844393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ROSS PT, DPT

Provider Business Mailing Address
First Line	:	120 COLEMANS XING
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-7115
Country	:	US
Telephone Number	:	937-578-7841
Fax Number	:	937-578-7891

Provider Business Practice Location Address
First Line	:	120 COLEMANS XING
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-7115
Country	:	US
Telephone Number	:	937-578-7841
Fax Number	:	937-578-7891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	03/23/2016

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